Joint pain and swelling: Difference between revisions
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[[image: | [[image:jointpain.jpg|right|thumb|300px|Like the picture on the [[pain]] page, this man has helpfully managed to get a red glow in the areas of pain. Less helpfully, all his skin has fallen off and he is dead. It can be very difficult to treat joint tenderness in deceased patients, although some [[alternative therapy|alternative therapies]] claim to be able to cure this. Obviously, they can't.]] | ||
===Definition=== | ===Definition=== | ||
[[Pain]] and swelling, in joints. | [[Pain]] and swelling, in joints. | ||
===Epidemiology=== | ===Epidemiology=== | ||
[[image:common.jpg]] Joint pain especially is incredibly common. Joint swelling is less so, but the two are almost always related. | [[image:common.jpg|left]] Joint pain especially is incredibly common. Joint swelling is less so, but the two are almost always related. | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
The pain can come from many causes; in destructive disease, its from nerve ending being exposed by damage to bone and cartilage, in non destructive conditions, I'm not sure where the pain comes from. | |||
===Clinical and Associated Features=== | ===Clinical and Associated Features=== | ||
The symptoms of joint pain will vary according to the cause. Symptoms like pain, swelling, stiffness, or warmth suggest joint inflammation. | |||
May also be: | |||
*redness, | |||
*painful to touch | |||
*reduced joint mobility. | |||
To separate rheumatoid and osteoarthritis, '''Rheumatoid arthritis''' is classically stiff and painful in the morning, getting looser and less painful as they move through the day. '''Osteoarthritis''' may not present with stiffness, and gets worse throughout the day. | |||
===Differential Diagnosis=== | ===Differential Diagnosis=== | ||
'''Degenerative''' | |||
*[[Osteoarthritis]] | |||
*General oldness, leading to worn out joints | |||
'''Inflammatory''': | |||
*[[Rheumatoid Arthritis]] | |||
*Other [[connective tissue disorders]] | |||
*GI complaints like [[Coeliac's]],[[Crohn's]] and [[Colitis]] | |||
'''Infective''': | |||
*Joint [[infection]] | |||
*[[Reactive arthritis]] | |||
'''Others''' (less common): | |||
*[[Allergic]] reaction - commonly to things like nuts, milk, caffeine, etc. | |||
*Chronic Fatigue Syndrome | |||
*[[Leukaemia]] | |||
===Investigations=== | ===Investigations=== | ||
Firstly check for inflammatory markers - [[ESR]] and [[CRP]]. Along with this, go for [[Rheumatoid factor]]. It's not very helpful often, but it can separate inflammatory conditions into seronegative and positive. | |||
Secondly, [[X-rays]] can show destructive damage, and some soft tissue issues. | |||
===Management=== | ===Management=== | ||
Based on the cause. In allergy, avoid the allergen, and taking antihistamines. In inflammatory arthritis, start with NSAIDs, moving on all the way to immunosuppression. | |||
Sometimes it may be necessary to undergo joint replacement, for example in severe hip or knee osteoarthritis. | |||
Latest revision as of 16:27, 1 April 2010
Definition
Pain and swelling, in joints.
Epidemiology
Joint pain especially is incredibly common. Joint swelling is less so, but the two are almost always related.
Pathophysiology
The pain can come from many causes; in destructive disease, its from nerve ending being exposed by damage to bone and cartilage, in non destructive conditions, I'm not sure where the pain comes from.
Clinical and Associated Features
The symptoms of joint pain will vary according to the cause. Symptoms like pain, swelling, stiffness, or warmth suggest joint inflammation.
May also be:
- redness,
- painful to touch
- reduced joint mobility.
To separate rheumatoid and osteoarthritis, Rheumatoid arthritis is classically stiff and painful in the morning, getting looser and less painful as they move through the day. Osteoarthritis may not present with stiffness, and gets worse throughout the day.
Differential Diagnosis
Degenerative
- Osteoarthritis
- General oldness, leading to worn out joints
Inflammatory:
- Rheumatoid Arthritis
- Other connective tissue disorders
- GI complaints like Coeliac's,Crohn's and Colitis
Infective:
- Joint infection
- Reactive arthritis
Others (less common):
- Allergic reaction - commonly to things like nuts, milk, caffeine, etc.
- Chronic Fatigue Syndrome
- Leukaemia
Investigations
Firstly check for inflammatory markers - ESR and CRP. Along with this, go for Rheumatoid factor. It's not very helpful often, but it can separate inflammatory conditions into seronegative and positive.
Secondly, X-rays can show destructive damage, and some soft tissue issues.
Management
Based on the cause. In allergy, avoid the allergen, and taking antihistamines. In inflammatory arthritis, start with NSAIDs, moving on all the way to immunosuppression.
Sometimes it may be necessary to undergo joint replacement, for example in severe hip or knee osteoarthritis.